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Company Name
Company Address
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Contact Name
Phone Number
Fax Number
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Shipment Commodity
Shipment Total Pieces
Shipment Total Weight (lbs)
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Footage of trailer
Maximum Height
Maximum Width
Fill in the following if less than truckload (LTL)
Dimension 1	×  ×  inches
Dimension 2	×  ×  inches
Dimension 3	×  ×  inches
Dimension 4	×  ×  inches
Dimension 5	×  ×  inches
Shipment Details
Number of skid spaces required
Origin City
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Destination City
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Required Pick Up Date	01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2009 2010 2011 2012 2013
Required Delivery Date	01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2009 2010 2011 2012 2013
Required Equipment	Van Flatbed Reefer Drop Deck Container Other:
Special Handling	Heat Hazmat Declared Value Tailgate Delivery Inside Delivery
Service Level	Regular/Intermodal Expedited Direct Drive
Comments	Please enter any comments or specific requirements here.

8510 Torbram Rd, Unit 64, Brampton, ON L6T 5C7 | Phone (647) 288-7162 | Contact Us